Patients must be at the heart of our NHS

Over 200,000 Londoners have waited more than four hours for treatment in London’s A&Es over the past year.

Dr Onkar Sahota AM is a Labour Assembly Member for Ealing and Hillingdon. A practicing GP, he is also London Assembly Labour Group Health spokesperson

Over 200,000 Londoners have waited more than four hours for treatment in London’s A&Es over the past year, with half of all hospital trusts failing to meet their obligation to treat 95 per cent patients within those four hours half of the time.

From life threatening emergencies to less serious but urgent needs, these figures are yet more evidence that the NHS is in crisis. Increased attendances, staff shortages and cuts to hospital beds throughout the year have led to a scenario where the usual pressures hospitals face during the cold months have continued throughout the summer, creating a crisis for all seasons.

Even with a short term cash fix, NHS leaders are getting ready for what is expected to be the harshest winter for London’s A&Es yet. With energy bills soaring and the cost of living outstripping take home pay, many families and older people will be making tough choices over heating their home, whilst the risk of excessive winter deaths is certain to increase.

At a time of huge challenge for London’s hospitals, plans to close or downgrade accident and emergency departments like Ealing and Charing Cross will place even more pressure on an overburdened system.

Later this week, the Department of Health will release the findings of Sir Bruce Keogh’s review of urgent and emergency care. It is expected that Keogh will recommend watering down the widely held notion of what constitutes an ‘A&E’. Ever since Jeremy Hunt uttered the words ‘different shape and size’ in relation to Ealing Hospital’s future setup, and the announcement by NHS England that no blue-light ambulances would stop at Ealing, we in west London have seen this coming.

There is a distinct difference between the need for highly specialised A&Es that are able to deal with major trauma, strokes and serious cardiac arrest and decent, local accident and emergency services. Already many trusts have reconstituted the way urgent and emergency care operates to offer alternatives to the four hour wait in A&E in the form of urgent care centres, staffed by GPs, able to deal with the most minor of ailments patients present at hospital with.

If Keogh does indeed introduce new tiers of urgent and emergency care, he will be adding even more complexity into an already overstretched system, risking increased levels of confusion as people with widely different local services struggle to understand which to access.

At the heart of the pledge to give families one named contact for the co-ordination of all health and care needs is the core belief that patients and families are better equipped to make the right choices over their care, whilst it should be the role of the NHS to facilitate those needs within the complex internal structures that can be sometimes impossible to navigate even for the most seasoned of medical professionals.

The government, in the midst of a winter A&E crisis risk turning emergency care into a Frankenstein like monster.

If the principle of ‘patient knows best’ is true for choosing care, then patients ought also to be at the heart of deciding how services should be configured in the short and medium term. It is not enough that NHS bosses communicate what they believe to be clinically sound proposals to the public.

The Independent Reconfiguration Panel appointed to review plans to close and downgrade A&E, maternity and other services in North West London described the public consultation as simply a communication exercise. That did not fully engage local people before it was too late in a genuine conversation about local need and achieving better clinical outcomes fundamentally undermined the principle of what it set out to achieve.

Perhaps by putting patients at the heart of decision making, clinical commissioning groups will be able to better demonstrate to the public that exercises in service reconfiguration are not just financially required, but are clinically led and reflect local need.

The London Assembly report into the winter A&E crisis can be viewed here

One Response to “Patients must be at the heart of our NHS”

  1. treborc

    I live in Wales if I was to get treatment in four hours I would think it was brilliant my normal waiting time is six to seven hours.

    Even under New labour you might be waiting four yours before the triage nurse saw you, you were only only waiting from the moment they saw you. So they would only see you when they knew the doctor would be ready.

    I use to watch all the cuts sore fingers and all the minor injuries getting treated before the more serious.

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